NPIMap

Organization Active NPI

Corcair Pyschological Services, LLC

  • Clinical Psychologist
  • Decatur, GA
National Provider Identifier
1124310727
Registry record updated May 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY003030 Issued in GA
Legal business name
CORCAIR PYSCHOLOGICAL SERVICES, LLC
Practice address
235 E Ponce de Leon Ave
Suite 110
Decatur, GA 30030-3452
Phone
(404) 542-5287
Fax
(888) 485-5215
NPI assigned
May 14, 2011
Last updated
May 14, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jill C Anderson, PSYDNPI 1972805786
Title
Owner
Phone
(404) 542-5287

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY003030 GA Primary

Addresses

Primary practice location

235 E Ponce de Leon Ave
Suite 110
Decatur, GA 30030-3452

Mailing address

235 E Ponce de Leon Ave
Suite 110
Decatur, GA 30030-3452
Phone (404) 542-5287

Other identifiers 1

IdentifierTypeStateIssuer
003101292AMedicaidGA

National Provider Directory

National Provider Directory

Locations

235 E Ponce de Leon Ave
Ste 110
Decatur, GA 30030
Phone (706) 280-6505

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305331200000",
    "number": "1124310727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 E PONCE DE LEON AVE",
            "address_2": "SUITE 110",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300303452",
            "telephone_number": "404-542-5287",
            "fax_number": "888-485-5215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 E PONCE DE LEON AVE",
            "address_2": "SUITE 110",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300303452",
            "telephone_number": "404-542-5287",
            "fax_number": "888-485-5215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORCAIR PYSCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-14",
        "last_updated": "2011-05-14",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-542-5287",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY003030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003101292A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.